Left-Sided Thoracoscopic Redo Esophageal Anastomosis for Intractable Post-Esophageal Atresia Stricture: Experience at Cairo University

Abstract

Introduction:

Redo surgeries for esophageal atresia (EA) present significant challenges due to adhesions within the pleural cavity, particularly when re-accessing the esophagus via the right side. ¹ This report describes a left-sided thoracoscopic approach for managing an intractable post-EA anastomotic stricture.

Patients and Methods:

A male infant was diagnosed with EA/tracheoesophageal fistula (TEF, type C) shortly after birth and underwent a right thoracoscopic primary repair. Postoperatively, a minor anastomotic leak was managed conservatively, and the infant was discharged on full oral feeds after 25 days of NICU admission. Subsequently, the patient experienced recurrent choking and aspiration, leading to multiple hospital admissions. Investigations revealed a tight anastomotic stricture that was refractory to eight sessions of endoscopic dilation and mitomycin-C application. To support caloric intake, a feeding gastrostomy was laparoscopically inserted. At one year of age, surgical resection and redo esophageal anastomosis were deemed necessary due to the persistent stricture. Given the likelihood of dense adhesions on the right side, a left-sided thoracoscopic approach was selected. The procedure was performed successfully under general inhalational anesthesia. The child was positioned prone, and four 5 mm ports were utilized. The optical port was inserted just below the tip of the scapula. The left working port was placed in the 3rd intercostal space in the mid-axillary line, while the right working port was positioned in the 6th intercostal space, midway between the posterior axillary line and the vertebral spine. An assistant port was inserted in the 8th intercostal space in the posterior axillary line. A minor anastomotic leak, noted on postoperative day 7, was managed conservatively. The child was discharged home after 36 days of hospitalization. During follow-up, only one session of endoscopic dilation was required 1 year post-discharge. At the latest follow-up, 8 months later, the child remained asymptomatic, with no evidence of recurrent stricture or gastroesophageal reflux disease on esophagogram and endoscopy.

Results and Conclusions:

The left-sided thoracoscopic approach is a feasible option for managing persistent post-EA strictures. Further studies with larger case series are needed to validate its efficacy and safety.

Financial Disclosures:

Seleim HM, Wishahy AMK, Elsoudi M, Magdy B, Elbarbary MM have no conflict of interest or financial ties to disclose.

This work conforms to the provisions of the Declaration of Helsinki in 1995 (as revised in Edinburgh, 2000). An informed parental consent was taken, and patient anonymity is preserved.

Authors have received and archived patient (parental) consent for video recording and publication in advance of the procedure.

No competing financial interests exist.

Runtime of video: 7 mins.